Mental health needs are rising nationwide, yet millions of Americans still go without care. Recent data show that only about half of those with a mental health condition — and fewer than one in four people with a substance abuse disorder — receive care.
Policymakers have responded with efforts to expand care access, such as the national 988 crisis hotline, and to increase involuntary interventions like forced medications and hospitalization. A new study from the School of Public Health at Washington University in St. Louis explores how the public views expansions in behavioral health-care policies, finding strong support for voluntary care over forced hospitalization or medication against a person’s will. The research, “Public Attitudes Toward Mental Health Treatment Policy,” was published Sept. 17 in JAMA Network Open.
Community-based programs — such as 24/7 crisis hotlines, walk-in centers and peer-led services — aim to keep people close to home and out of hospitals.
“Community-based services, including those led by peers, are proven to improve population health and reduce reliance on costly institutional care,” said Morgan C. Shields, an assistant professor at the School of Public Health and first author of the study. “Our findings show strong bipartisan agreement that these services should be prioritized — a rare point of unity in today’s polarized political climate.”
Yet, even as Americans support community-based, voluntary care, recent federal actions are taking a different approach. In July, the federal government issued the executive order “Ending Crime and Disorder on America’s Streets.” This order directed federal agencies to reverse judicial protections and expand the use of civil commitment — a legal process that allows someone to be treated for mental illness without their consent.
The order specifically targets people experiencing homelessness and serious mental illness. This policy shift intensifies debates over how to balance public safety, individual rights and effective, evidence-based care.
Researchers surveyed 1,442 U.S. adults between Jan. 17 and Feb. 12 using a nationally representative online panel administered through Qualtrics. Quota sampling was applied for gender, age, race, ethnicity, income, education and region to reflect U.S. census population estimates. Participants rated their support for different mental health-care policies on a nine-point scale.
The survey examined several key areas: community-based services; peer-led services provided by individuals with lived experience of mental health conditions; treatment and recovery; forced medications; forced short-term inpatient psychiatric stays; forced long-term inpatient psychiatric stays; and forced treatment for substance use conditions. Researchers also collected information about political party affiliation to analyze differences across groups.
Nearly three-quarters of respondents (73%) supported expanding access to community-based services, with similar levels across party lines: 78% among Democrats, 72% among Republicans and 71% among Independents. Similarly, most respondents across party lines supported expanding peer-led services.
In contrast, support dropped for policies that would allow treatment to be forced on someone against their will. Just 40% favored forced psychiatric medication, 45% supported short-term involuntary hospitalization and 42% supported long-term hospitalization. Mandated substance-use treatment drew slightly more support, at 53%.
Democrats were slightly less supportive of policies involving forced treatment than Republicans, while Independents consistently reported lower support across all policies.
“At a national level, policies have swung back and forth between institutional, involuntary approaches and community-based solutions,” Shields said. “This research suggests a path forward: investing in community services that are both empirically and politically viable.”
She added that the team hopes these findings will guide policymakers and community leaders toward solutions that improve access to care while protecting individual rights. The paper was co-authored by Nev Jones, at the University of Pittsburgh, Shyamal Sharma, at Brandeis University, and Susan H. Busch, at Yale University.
